Spotting the signs of PCOS

Key takeaways

PCOS is a common hormonal condition that affects around 1 in 10 women, and symptoms vary a lot from person to person.
It's usually diagnosed when you have at least two of three features: irregular periods, signs of high androgens, and polycystic-looking ovaries on a scan.
There's no cure, but symptoms can be managed well, and a diagnosis means you can get the right long-term health checks.

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Polycystic ovary syndrome (PCOS) is a common hormonal condition, affecting around 1 in 10 women, and its main signs are irregular or missed periods, signs of higher 'male-type' hormones such as excess facial or body hair and acne, and sometimes ovaries that look polycystic on a scan. Symptoms vary a lot from person to person, and it is usually diagnosed when you have at least two of these three features and other causes have been ruled out. There's no cure, but symptoms can be managed well, so it's worth seeing a doctor if you recognise the signs.

Read: PCOS symptoms and signs: what to look for and how it's diagnosed

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What is PCOS?

PCOS is a hormonal condition that affects how your ovaries work. Despite the name, you don't have to have cysts to have PCOS: the 'cysts' seen on scans are actually lots of small, partly developed follicles (fluid-filled sacs that contain eggs) that haven't released an egg.

The exact cause isn't fully understood, but it often runs in families and is linked to higher levels of androgens (hormones such as testosterone, which everyone has in some amount) and to insulin resistance, where your body doesn't respond to insulin as well as it should.

Common symptoms of PCOS

PCOS looks different in everyone. Some people have many symptoms, others only one or two. The most common signs are:

Irregular or missed periods — cycles that are often longer than 35 days, very unpredictable, or absent
Excess hair growth on the face, chest, back or tummy (called hirsutism)
Acne or oily skin, especially if it continues beyond your teens
Thinning hair or hair loss from the head
Weight gain or finding it hard to lose weight
Difficulty getting pregnant, because ovulation happens irregularly or not at all

Some people also notice darker, velvety patches of skin in body folds such as the neck or armpits, which can be a sign of insulin resistance. Many people with PCOS say the condition affects their mood and self-esteem too — that's real, and worth mentioning to your doctor.

How is PCOS diagnosed?

There isn't a single test for PCOS. Doctors usually diagnose it if you have at least two of these three features:

irregular periods or signs that you aren't ovulating regularly
signs of high androgens, either symptoms like excess hair or acne, or raised levels on a blood test
polycystic-looking ovaries on an ultrasound scan

Your doctor will also want to rule out other conditions that can look similar, such as thyroid problems or high prolactin, usually with blood tests. In teenagers, scans are generally not used to diagnose PCOS, because ovaries naturally have many follicles in the years after periods begin.

It helps to bring a record of your cycles and symptoms to your appointment, along with a note of any family history of PCOS or type 2 diabetes.

Why getting diagnosed matters

PCOS isn't only about periods and skin. It's linked to a higher risk of some longer-term health problems, including type 2 diabetes, high cholesterol, high blood pressure and sleep apnoea. If you have very few periods over a long time, the lining of the womb can build up, which can increase the risk of womb (endometrial) cancer — this is one reason doctors may suggest treatment to make sure you have regular bleeds.

A diagnosis means you can get the right checks over time, such as blood sugar and blood pressure tests, and support that fits your goals.

How PCOS is treated and managed

There's no cure, but treatment can make a big difference. What's right for you depends on your symptoms and whether you want to get pregnant:

Lifestyle — regular movement and a balanced diet can improve symptoms and insulin resistance. For people who are overweight, even modest weight loss can help regulate periods, but PCOS can make weight harder to manage, so be kind to yourself.
Hormonal contraception can regulate bleeding and help with acne and hair growth.
Other medicines may be offered for insulin resistance, excess hair or acne.
Fertility treatment, including medicines that help you ovulate, can help if you're trying to conceive.
Hair removal and skincare options can help with how you feel day to day.

Your doctor can talk you through the benefits and side effects of each option.

When to see a doctor

Make an appointment if you have irregular or absent periods, excess hair growth, persistent acne, hair thinning, or you've been trying to get pregnant without success. You don't need to have every symptom.

See a doctor promptly if you have very heavy or prolonged bleeding, bleeding after sex, or symptoms that come on suddenly or quickly get worse — for example, rapid new hair growth or a deepening voice — as these need checking for other causes.

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